OPA8 BEYOND USUAL CASES: SETTING UP MULTIDISCIPLINARY TEAM MEETINGS (MDTS) WITH BEDSIDE AWAKE NASOENDOSCOPY IN SLEEP MEDICINE

Sarvin VIGNESH1, Nai-Chien HUAN1, Hema Yamini RAMARMUTY1, Saravanan GOPALAN2, Yazid POL ONG3, Ahmad NORDIN3, Muhammad Fuaz MAHFUZ3 , Wei Keat OOI4 & Kunji Kannan SIVARAMAN KANNAN1
1. Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
2. Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
3. Department of Otolaryngology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
4. Department of Upper Gastrointestinal, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia

Objective

In response to the fragmented care pathways for patients with sleep disorders, we implemented Multidisciplinary Team (MDT) meetings at Hospital Queen Elizabeth, Sabah, to streamline discussion and management of complex sleep disorders with the aim of improving patients care. 

Methods

From December 2022 to June 2024, 13 MDT meetings were conducted involving specialists from respiratory medicine, otolaryngology (ENT), oromaxillofacial surgery (OMFS), and bariatric surgery. Further expertise from other disciplines such as endocrinology, neurology, dietetics, physiotherapy, and device representatives were enlisted as needed. Each case discussion included structured steps: case review, imaging evaluation, patient assessment, bedside nasoendoscopy as needed, and communicating outcomes to patients.

Results

We reviewed 41 patients (22 males, mean age 46.5-years-old, mean BMI 31.4, mean Epworth Sleepiness Scale 10.6, mean STOP-BANG score 4.48) with various sleep disorders, primarily moderate to severe obstructive sleep apnea (OSA) in non-obese individuals (n=14, 34.1%). Other indications included symptomatic patients with discordant AHI (n=12, 29.2%), mild OSA management (n=5, 12.2%), OSA with concurrent tonsillar pathology (n=6, 14.6%) and others (n=4, 9.7%). MDT discussions led to recommendations such as continuous or bi-level positive-airway pressure (PAP) device prescriptions on 18 instances; skeletal surgeries, tonsillectomies or bariatric surgery on 16 instances; mandibular advancement devices on 7 instances; polysomnography on 5 instances and other recommendations on 5 instances. No adverse events occurred during the 35 bedside nasoendoscopies.

Conclusion

MDT meetings significantly enhanced the care of sleep disorder patients by enabling thorough assessments and personalized treatment plans. Future efforts should focus on expanding involvements, utilizing tele-health, and conducting further research ensuring efficient patient-centered care delivery.